| NPI | 1669183521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE L STOVER Owner 269-370-9772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2023-05-16 |